Epidural Injections

What are Epidural injections?

An Epidural Injection (ESI) is the delivery of powerful anti-inflammatory medicine directly into the space outside of the sac of fluid around your spinal cord. This area is called the epidural space.

The goals of an epidural steroid injection are to:

• Control pain by reducing inflammation in and around the nerve roots
• Improve mobility and function in the lower back and legs
• Allow the patient to participate in and make progress with a comprehensive physical therapy and rehabilitation program

What are the conditions epidural steroid injections are used for?

Epidural injections are used to manage a type of chronic pain known as lumbar radicular pain, which is caused by spinal nerve root inflammation and irritation in your low back. Lumbar radicular pain is often called sciatica. Lumbar radicular pain can cause the following symptoms, which can radiate from your low back down the back of your leg below your knee to your calf and/or foot:

• Pain
• Numbness.
• Muscle weakness.
• Tingling.

Many conditions can irritate your spinal nerve roots in your low back and cause lumbar radiculopathy (sciatica), including:

• Lumbar herniated disk: This condition is also commonly called a slipped, ruptured, or bulging disk. Disks have soft, gel-like centers and a firmer outer layer. Over time or with an injury, the outer layer weakens and can crack. A lumbar herniated disk happens when the inner substance pushes through a crack in one of the disks between two vertebrae in your low back. The leaked material may press on, irritate and/or pinch nearby spinal nerves.
• Lumbar degenerative disc diseases: This condition happens when the cushioning in between the vertebrae in your low back begins to wear away. A degenerated disk could cause local inflammation in your spinal nerve roots.
• Lumbar spinal stenosis: This condition is the narrowing of one or more spaces within your lumbar spine. Less space within your spine reduces the amount of space available for your spinal nerve roots. A tightened space can cause the nerves to become irritated or pinched, which can lead to low back pain, especially with repeated activity like walking.
• Lumbar osteoarthritis (lumbar spondylosis): This condition involves changes to the bones, disks, and joints in your low back caused by the normal wear-and-tear of aging. Lumbar osteoarthritis can lead to the narrowing of the interior of your spinal column in your low back or in the openings where spinal nerves exit, which can cause inflammation and irritation to the nerves.

Other conditions that may be treated with Epidural Injections include:

• Localized low back pain (axial back pain): Axial low back pain can vary widely and have numerous causes. It can be a sharp or dull pain that you experience constantly or infrequently, and the pain can range from mild to severe.
• Neurogenic claudication: This condition happens from compression of the spinal nerves in your lumbar spine. It can cause pain or tingling in your low back and one or both of your legs, and hips. These symptoms are especially present
• when you’re standing upright or walking.

Benefits

• Reduce nerve pain and inflammation. Steroids decrease the production of inflammatory chemicals and reduce the sensitivity of nerve fibers to pain, generating fewer pain signals.
• Limit oral medication. Pain relief from these injections may help limit or eliminate the need for oral medications, some of which may have side effects when taken long-term.
• Continue or re-engage in physical therapy. This injection may provide sufficient pain relief to allow a patient to progress with a rehabilitative physical therapy program.
• Postpone surgery. Pain relief experienced from lumbar epidural steroid injections may help postpone surgery, and if physical therapy is effective, it may eliminate the need for surgical intervention.

Potential Risks and Contraindications for Epidural Injections

Epidural steroid injections are considered relatively safe and minimally invasive. Temporary side effects may occur in some cases and include (but are not limited to):

• Post-injection pain
• Nausea
• Headache
• Dizziness
• Fainting (vasovagal attack)
• Flushing of the face